Three types of lymphangiomas are commonly identified: capillary, cavernous, and cystic. Cystic type is the one commonly found in the abdomen and/or retroperitoneal location, may also be uniloculated or multiloculated [1-4]

All these above mentioned perirenal lymphangiomas have a very low incidence which make them difficult to diagnose, these benign lesions have no sex predilection and have been reported at all ages, from birth to 90 years of age, mostly occur during childhood and over the age of 40 [1,3,5]. Renal lymphangiomas can be diagnosed incidentally by radiological imaging methods or patients may present themselves with lumbar pain or vague abdominal symptoms, other possible clinical manifestations are hypertension, hematuria, proteinuria, intracystic hemorrhage or chyluria [2,4,6]. Lymphangiomas may be widened and symptoms may become exacerbated during pregnancy but, however children may be presented with only nephromegaly and may be associated with obstructive uropathy, lymphangiomas in adults are usually characterized by peripelvic and perirenal thin-walled cysts [1-6].

Perirenal and peripelvic involvements are usually seen in most cases, although some of them may be exclusively perirenal as seen in our patient (Perirenal and periurethral localization).

Generally, diagnosis is acquired by ultrasound(US) and/or CT scan, which are both very sensitive and specific; CT and US show the discrete cystic nature of the lymphangioma with a smooth, thin wall and septa, but sometimes irregular appearance with calcifications, CT appearance of the cyst can vary from water density to higher densities representing an increased mucoid, hemorrhagic fluid and/or calcium [6,7]. At MRI, lymphangiomas appear heterogenous low signal intensity on T1-weighted images and high signal intensity on T2-weighted images with interseptated masses, but may present differentiating signals secondary to varying amounts of protein or hemorrhage [6-8].

The differential diagnosis of cystic lymphangioma includes:Policystic kidney disease, tumors such as liposarcoma,fibrosarcoma,leiomyosarcoma,malignant teratomas and multilocular cystic nephroma, which are predominantly cystic or necrotic, but these malignancies usually contain substantial solid components; abscess and urinoma may also produce a similar appearance, but almost all these conditions can be differentiated with the help of clinical history, normal biochemical parameters and with typical radiological imaging findings of perirenal and parapelvic involvement sparing the renal parenchyma [3,5,8-10] Endoscopic ultrasound guided fine needle aspiration is recommended in some previous reports, which may aid to the definitive diagnosis and further guide to the subsequent therapeutic strategies, the choice of treatment depends on type, size and location of the cyst.If lymphangiomas of the kidney are small and do not cause any symptoms, they don’t  need to be surgically treated, because of their benign natures [2,5,9,11].

Surgery is often required to deteriorate symptoms and for definitive diagnosis, since radiological studies are often unable to differentiate lymphangiomas from other cystic tumoral growths.Nevertheless, the sacrifice of adjacent structures must be avoided, and in difficult cases surgical interventions and non-surgical methods such as sclerotherapy, may be combined together sequentially [2,9,11] Surgical excision can be performed via either laparotomy or laparoscopy and injection of sclerosing agents into lymphangioma has been indicated in the relevant literature for non-surgical candidates. The optimal satisfactory treatment is complete surgical excision,resulting an excellent prognosis [9,11].

In our case, A left perirenal and periurethral cystic lesion, named to be Lymphangioma was discovered incidentally in the Abdominal CT.She had no specific complaints for perirenal Lymphangioma and routine follow-up for this cystic lesion was recommended as uroradiological approach did not indicate any surgical methods and/or sclerosing therapy.